Membrane Retraction Technique in Bypass Surgery for the Treatment of Adult Moyamoya Disease with Deep-Seated Recipient Artery

Abstract BACKGROUND: Postoperative seizure, well-known in association with other pathologies, has been rarely discussed in adult moyamoya disease. OBJECTIVE: We evaluated postoperative seizures in adult patients with moyamoya undergoing revascularization surgery. METHODS: From 2001 to 2007, 43 adult patients with moyamoya disease underwent 53 revascularization surgeries, consisting of direct bypass with or without indirect bypass. Incidence and profile of postoperative seizures were investigated, with evaluation of influencing factors. Multivariable analysis using a generalized estimation equation was performed to determine which factors were related to postoperative seizure. RESULTS: Seizures developed in 10 sides (18.9%) after revascularization for moyamoya disease, including immediate (<24 hours, n = 0), early (1–7 days, n = 5), late (8–30 days, n = 0), and delayed seizures (≥1 month, n = 7). Early and subsequent delayed seizures developed in the same lesions in 2 patients. Seizures developed only in the patients with combined direct and indirect revascularization. Postoperative temporary neurological deficits with imaging abnormalities were significantly related to postoperative nondelayed seizures (P = .02). Delayed seizures were significantly different according to the location of the recipient artery (P = .03), especially with the frontal branches. By multivariable analysis, revascularization using frontal branches trended toward increased incidence of delayed postoperative seizure, with adjusted odds ratio of 13.78 (95% confidence interval, 1.7-114.1). CONCLUSION: In adult patients with moyamoya disease, the incidence of delayed postoperative seizure seems to be higher than that of other pathologies. The delayed, pronounced formation of synangiosis in moyamoya disease may be related to the development of such delayed postoperative seizures, especially when the location of the recipient artery is frontal.

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Can Combined Bypass Surgery at Middle Cerebral Artery Territory Save Anterior Cerebral Artery Territory in Adult Moyamoya Disease?

Neurosurgery ◽

10.1227/neu.0000000000001354 ◽

2017 ◽

Vol 80 (3) ◽

pp. 431-438 ◽

Cited By ~ 13

Author(s):

Won-Sang Cho ◽

Jeong Eun Kim ◽

Jin Chul Paeng ◽

Minseok Suh ◽

Yong-il Kim ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Moyamoya Disease ◽

Cerebral Artery ◽

Bypass Surgery ◽

Anterior Cerebral Artery ◽

Middle Cerebral Artery Territory ◽

Reservoir Capacity ◽

Hemodynamic Changes ◽

Adult Moyamoya Disease

Abstract BACKGROUND: Patients with moyamoya disease are frequently encountered with improved symptoms related to anterior cerebral artery territory (ACAt) and middle cerebral artery territory (MCAt) after bypass surgery at MCAt. OBJECTIVE: To evaluate hemodynamic changes in MCAt and ACAt after bypass surgery in adult moyamoya disease. METHODS: Combined bypass surgery was performed on 140 hemispheres in 126 patients with MCAt symptoms. Among them, 87 hemispheres (62.1%) accompanied preoperative ACAt symptoms. Clinical, hemodynamic, and angiographic states were evaluated preoperatively and approximately 6 months after surgery. RESULTS: Preoperative symptoms resolved in 127 MCAt (90.7%) and 82 ACAt (94.3%). Hemodynamic analysis of total patients showed a significant improvement in MCAt basal perfusion and reservoir capacity (P < .001 and P = .002, respectively) and ACAt basal perfusion (P = .001). In a subgroup analysis, 82 hemispheres that completely recovered from preoperative ACAt symptoms showed a significant improvement in MCAt basal perfusion and reservoir capacity (P < .001 and P = .05, respectively) and ACAt basal perfusion (P = .04). Meanwhile, 53 hemispheres that had never experienced ACAt symptoms significantly improved MCAt basal perfusion and reservoir capacity (P < .001 and P = .05, respectively); however, no ACAt changes were observed. A qualitative angiographic analysis demonstrated a higher trend of leptomeningeal formation from MCAt to ACAt in the former subgroup (P = .05). During follow-up, no ACAt infarctions were observed. CONCLUSION: Combined bypass surgery at MCAt resulted in hemodynamic improvements in ACAt and MCAt, especially in patients with preoperative ACAt symptoms.

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Angiographic and clinical outcomes of non-patent anastomosis after bypass surgery in adult moyamoya disease

Acta Neurochirurgica ◽

10.1007/s00701-018-3733-3 ◽

2019 ◽

Vol 161 (2) ◽

pp. 379-384 ◽

Cited By ~ 6

Author(s):

Seung Hwan Kim ◽

Hyungon Lee ◽

Minwook Yoo ◽

Seongjin Jin ◽

Sungjoon Lee ◽

...

Keyword(s):

Clinical Outcomes ◽

Moyamoya Disease ◽

Bypass Surgery ◽

Adult Moyamoya Disease

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Application of Intraoperative Electrocorticography in Precise Bypass Surgery of Adult Moyamoya Disease: A Preliminary Study

Neurosurgery ◽

10.1093/neuros/nyz310_504 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Yu Lei

Keyword(s):

Postoperative Complications ◽

Moyamoya Disease ◽

Bypass Surgery ◽

Regional Blood Flow ◽

Beta Band ◽

Surgical Revascularization ◽

Traditional Group ◽

Lower Amplitude ◽

Significant Difference ◽

Adult Moyamoya Disease

Abstract INTRODUCTION Postoperative complications of surgical revascularization are still difficult to predict because of poor knowledge of the underlying pathophysiological process. Since the aim of the surgery is to improve brain dynamics by increasing regional blood flow, we hypothesize that postoperative complications are determined by aberrant electrophysiological changes. Thus, we tried to evaluate the clinical significance of intraoperative electrocorticography (ECoG) in precise bypass surgery of adult moyamoya disease (MMD). METHODS Ninety-one adult patients operated by the same neurosurgeon in our institute was involved (26 in the precise group, 65 in the traditional group). Two 1 × 6 subdural electrode grids were placed parallelly on the middle frontal gyrus and superior temporal gyrus to record ECoG data continuously during the procedure in the precise group. For patients with several candidate recipient M4 arteries, we selected the one closer to the cortex with lower amplitude in the beta band and lower frequency. Postoperative complications, 1-mo follow-up NIHSS and MMSE scores were noted. The power spectral denstity (PSD) values, and its parameter of (delta + theta)/(alpha + beta) ratio (DTABR) were adopted as ECoG metrics. RESULTS No significant difference was noticed between the 2 groups in either postoperative NIHSS or MMSE, while postoperative complication of the precise group was significantly lower than that of the traditional group (P < .05). In the precise group, the post/preop DTABR ratio in the bypass area was significantly correlated with postoperative NIHSS (P = .014 r2 = 0.289) and MMSE changes (P = .007 r2 = 0.266). While in the remote area, neither postoperative NIHSS nor MMSE changes showed significant correlation with post/pre-op DTABR ratio (P > .05). Additionally, in the precise group, patients with postoperative complications exhibited significantly higher DTABR (1.67 ± 0.33 vs 0.95 ± 0.08, P = .003) and PSD of thata band than those without postoperative complications in only bypass area. CONCLUSION This study was the first to explain and guide surgical revascularization from the perspective of electrophysiology. Intraoperative ECoG was not only sensitive to reflect and predict postoperative neurological and cognitive performance, but also usable as a reference for recipient artery selection.

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Angiographic Results of Indirect and Combined Bypass Surgery for Adult Moyamoya Disease

Journal of Cerebrovascular and Endovascular Neurosurgery ◽

10.7461/jcen.2012.14.3.216 ◽

2012 ◽

Vol 14 (3) ◽

pp. 216 ◽

Cited By ~ 17

Author(s):

In Jae Choi ◽

Sung Jin Cho ◽

Jae Chil Chang ◽

Sukh Que Park ◽

Hyung Ki Park

Keyword(s):

Moyamoya Disease ◽

Bypass Surgery ◽

Adult Moyamoya Disease

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Changes in superficial temporal artery blood flow and cerebral hemodynamics of moyamoya disease after extracranial-intracranial bypass surgery

Journal of Cerebral Blood Flow & Metabolism ◽

10.1038/sj.jcbfm.9591524.0120 ◽

2005 ◽

Vol 25 (1_suppl) ◽

pp. S120-S120 ◽

Cited By ~ 1

Author(s):

Shigeru Fujimoto ◽

Kazunori Toyoda ◽

Tooru Inoue ◽

Yoko Yokoyama ◽

Juro Jinnouchi ◽

...

Keyword(s):

Blood Flow ◽

Moyamoya Disease ◽

Bypass Surgery ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Cerebral Hemodynamics ◽

Artery Blood Flow

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Intralateral and Perilateral Ventricular Arteries on Original Axial Magnetic Resonance Angiography in Adult Moyamoya Disease

European Neurology ◽

10.1159/000514429 ◽

2021 ◽

Vol 84 (2) ◽

pp. 119-123

Author(s):

Mami Ishikawa ◽

Satoshi Terao ◽

Hiroshi Kagami ◽

Makoto Inaba ◽

Heiji Naritaka

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Cerebral Infarction ◽

Moyamoya Disease ◽

Disease Onset ◽

Time Of Flight ◽

Unruptured Aneurysms ◽

Tof Mra ◽

Adult Moyamoya Disease

Background: Patients with moyamoya disease often develop cerebral infarction and hemorrhage, but the ischemic and hemorrhagic subtypes are difficult to diagnose prior to disease onset. We aimed to differentiate the ischemic and hemorrhagic subtypes of moyamoya disease by analyzing the intralateral and perilateral ventricular arteries on the original axial magnetic resonance angiography (MRA) images. Methods: We retrospectively analyzed the intralateral and perilateral ventricular arteries on the original axial time-of-flight (TOF)-MRA images of 18 patients with hemorrhagic moyamoya disease, 25 patients with ischemic moyamoya disease, and 22 control patients with unruptured aneurysms. Results: There were significantly more intralateral and perilateral ventricular arteries on the original axial MRA images in the patients with hemorrhagic moyamoya disease (6.3 ± 2.7) than in those with ischemic moyamoya disease (0.8 ± 0.9) and those with unruptured aneurysms (0.4 ± 0.8). Conclusion: The intralateral and perilateral ventricular arteries on the original axial TOF-MRA images might suggest the hemorrhagic type of moyamoya disease prior to onset.

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